The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction: a comparison survival in two cohorts collected in 1995 and 2003

Christian Lewinter; John M Bland; Simon Crouch; Patrick Doherty; Robert J Lewin; Lars Køber; Alistair S Hall; Christopher P Gale

doi:10.1177/2047487312469124

The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction: a comparison survival in two cohorts collected in 1995 and 2003

Christian Lewinter, John M Bland, Simon Crouch, Patrick Doherty, Robert J Lewin, Lars Køber, Alistair S Hall, Christopher P Gale

Department of Clinical Medicine

8 Citations (Scopus)

Abstract

BACKGROUND: International guidelines recommend referral for cardiac rehabilitation (CR) after acute myocardial infarction (AMI). However, the impact on long-term survival after CR referral has not been adjusted by time-variance. We compared the effects of CR referral after hospitalization for AMI in two consecutive decades.

METHODS AND RESULTS: A total of 2196 and 2055 patients were recruited in the prospective observational studies of the Evaluation of the Methods and Management of Acute Coronary Events (EMMACE) -1 and 2 in 1995 and 2003, (1995: median age 72 years, 39% women, 74% referred vs 2003: median age 71 years, 36% women, 64% referred) and followed up through September 2010. Survival functions showed CR referral to be an independent predictor for survival in 2003, but not in 1995 (hazard ratio (HR), 0.90; 95% confidence interval [CI]; 0.70 to 1.17, p = 0.44 in 1995 vs HR, 0.80; 95% CI, 0.66 to 0.96, p = 0.02 in 2003) when patients entered the model at three months after discharge and had a common exit at 90 months. Significant positive and negative predictors for CR referral were beta-blocker prescription (+), reperfusion (+) and age (-) in 1995, and reperfusion (+), revascularization (+), heart failure (HF) (+), antiplatelets (+), angiotensin-converting-enzyme inhibitor (ACE-I) (+), statins (+), diabetes (-), and the modified Global Registry of Acute Cardiac Events (GRACE) risk score (-) in 2003.

CONCLUSIONS: CR referral was associated with improved survival in 2003, but not in 1995 in patients admitted with acute MI.

Original language	English
Journal	European Journal of Preventive Cardiology
Volume	21
Issue number	2
Pages (from-to)	163-171
Number of pages	9
ISSN	2047-4873
DOIs	https://doi.org/10.1177/2047487312469124
Publication status	Published - Feb 2014

Keywords

Age Factors
Aged
Aged, 80 and over
Cardiovascular Agents
Comorbidity
England
Female
Hospitalization
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Infarction
Myocardial Revascularization
Outcome and Process Assessment (Health Care)
Proportional Hazards Models
Prospective Studies
Referral and Consultation
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1177/2047487312469124

https://academic.oup.com/eurjpc/article-pdf/21/2/163/34271965/eurjpc0163.pdf

Cite this

Lewinter, C., Bland, J. M., Crouch, S., Doherty, P., Lewin, R. J., Køber, L., Hall, A. S., & Gale, C. P. (2014). The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction: a comparison survival in two cohorts collected in 1995 and 2003. European Journal of Preventive Cardiology, 21(2), 163-171. https://doi.org/10.1177/2047487312469124

The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction : a comparison survival in two cohorts collected in 1995 and 2003. / Lewinter, Christian; Bland, John M; Crouch, Simon et al.

In: European Journal of Preventive Cardiology, Vol. 21, No. 2, 02.2014, p. 163-171.

Research output: Contribution to journal › Journal article › Research › peer-review

Lewinter, C, Bland, JM, Crouch, S, Doherty, P, Lewin, RJ, Køber, L, Hall, AS & Gale, CP 2014, 'The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction: a comparison survival in two cohorts collected in 1995 and 2003', European Journal of Preventive Cardiology, vol. 21, no. 2, pp. 163-171. https://doi.org/10.1177/2047487312469124

@article{dccc9bdbe5fd48568c5a145b2e5ba83a,

title = "The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction: a comparison survival in two cohorts collected in 1995 and 2003",

abstract = "BACKGROUND: International guidelines recommend referral for cardiac rehabilitation (CR) after acute myocardial infarction (AMI). However, the impact on long-term survival after CR referral has not been adjusted by time-variance. We compared the effects of CR referral after hospitalization for AMI in two consecutive decades.METHODS AND RESULTS: A total of 2196 and 2055 patients were recruited in the prospective observational studies of the Evaluation of the Methods and Management of Acute Coronary Events (EMMACE) -1 and 2 in 1995 and 2003, (1995: median age 72 years, 39% women, 74% referred vs 2003: median age 71 years, 36% women, 64% referred) and followed up through September 2010. Survival functions showed CR referral to be an independent predictor for survival in 2003, but not in 1995 (hazard ratio (HR), 0.90; 95% confidence interval [CI]; 0.70 to 1.17, p = 0.44 in 1995 vs HR, 0.80; 95% CI, 0.66 to 0.96, p = 0.02 in 2003) when patients entered the model at three months after discharge and had a common exit at 90 months. Significant positive and negative predictors for CR referral were beta-blocker prescription (+), reperfusion (+) and age (-) in 1995, and reperfusion (+), revascularization (+), heart failure (HF) (+), antiplatelets (+), angiotensin-converting-enzyme inhibitor (ACE-I) (+), statins (+), diabetes (-), and the modified Global Registry of Acute Cardiac Events (GRACE) risk score (-) in 2003.CONCLUSIONS: CR referral was associated with improved survival in 2003, but not in 1995 in patients admitted with acute MI.",

keywords = "Age Factors, Aged, Aged, 80 and over, Cardiovascular Agents, Comorbidity, England, Female, Hospitalization, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Myocardial Infarction, Myocardial Revascularization, Outcome and Process Assessment (Health Care), Proportional Hazards Models, Prospective Studies, Referral and Consultation, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome",

author = "Christian Lewinter and Bland, {John M} and Simon Crouch and Patrick Doherty and Lewin, {Robert J} and Lars K{\o}ber and Hall, {Alistair S} and Gale, {Christopher P}",

year = "2014",

month = feb,

doi = "10.1177/2047487312469124",

language = "English",

volume = "21",

pages = "163--171",

journal = "European Journal of Preventive Cardiology",

issn = "2047-4873",

publisher = "SAGE Publications",

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TY - JOUR

T1 - The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction

T2 - a comparison survival in two cohorts collected in 1995 and 2003

AU - Lewinter, Christian

AU - Bland, John M

AU - Crouch, Simon

AU - Doherty, Patrick

AU - Lewin, Robert J

AU - Køber, Lars

AU - Hall, Alistair S

AU - Gale, Christopher P

PY - 2014/2

Y1 - 2014/2

N2 - BACKGROUND: International guidelines recommend referral for cardiac rehabilitation (CR) after acute myocardial infarction (AMI). However, the impact on long-term survival after CR referral has not been adjusted by time-variance. We compared the effects of CR referral after hospitalization for AMI in two consecutive decades.METHODS AND RESULTS: A total of 2196 and 2055 patients were recruited in the prospective observational studies of the Evaluation of the Methods and Management of Acute Coronary Events (EMMACE) -1 and 2 in 1995 and 2003, (1995: median age 72 years, 39% women, 74% referred vs 2003: median age 71 years, 36% women, 64% referred) and followed up through September 2010. Survival functions showed CR referral to be an independent predictor for survival in 2003, but not in 1995 (hazard ratio (HR), 0.90; 95% confidence interval [CI]; 0.70 to 1.17, p = 0.44 in 1995 vs HR, 0.80; 95% CI, 0.66 to 0.96, p = 0.02 in 2003) when patients entered the model at three months after discharge and had a common exit at 90 months. Significant positive and negative predictors for CR referral were beta-blocker prescription (+), reperfusion (+) and age (-) in 1995, and reperfusion (+), revascularization (+), heart failure (HF) (+), antiplatelets (+), angiotensin-converting-enzyme inhibitor (ACE-I) (+), statins (+), diabetes (-), and the modified Global Registry of Acute Cardiac Events (GRACE) risk score (-) in 2003.CONCLUSIONS: CR referral was associated with improved survival in 2003, but not in 1995 in patients admitted with acute MI.

AB - BACKGROUND: International guidelines recommend referral for cardiac rehabilitation (CR) after acute myocardial infarction (AMI). However, the impact on long-term survival after CR referral has not been adjusted by time-variance. We compared the effects of CR referral after hospitalization for AMI in two consecutive decades.METHODS AND RESULTS: A total of 2196 and 2055 patients were recruited in the prospective observational studies of the Evaluation of the Methods and Management of Acute Coronary Events (EMMACE) -1 and 2 in 1995 and 2003, (1995: median age 72 years, 39% women, 74% referred vs 2003: median age 71 years, 36% women, 64% referred) and followed up through September 2010. Survival functions showed CR referral to be an independent predictor for survival in 2003, but not in 1995 (hazard ratio (HR), 0.90; 95% confidence interval [CI]; 0.70 to 1.17, p = 0.44 in 1995 vs HR, 0.80; 95% CI, 0.66 to 0.96, p = 0.02 in 2003) when patients entered the model at three months after discharge and had a common exit at 90 months. Significant positive and negative predictors for CR referral were beta-blocker prescription (+), reperfusion (+) and age (-) in 1995, and reperfusion (+), revascularization (+), heart failure (HF) (+), antiplatelets (+), angiotensin-converting-enzyme inhibitor (ACE-I) (+), statins (+), diabetes (-), and the modified Global Registry of Acute Cardiac Events (GRACE) risk score (-) in 2003.CONCLUSIONS: CR referral was associated with improved survival in 2003, but not in 1995 in patients admitted with acute MI.

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Cardiovascular Agents

KW - Comorbidity

KW - England

KW - Female

KW - Hospitalization

KW - Humans

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Myocardial Revascularization

KW - Outcome and Process Assessment (Health Care)

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Referral and Consultation

KW - Risk Assessment

KW - Risk Factors

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1177/2047487312469124

DO - 10.1177/2047487312469124

M3 - Journal article

C2 - 23180866

SN - 2047-4873

VL - 21

SP - 163

EP - 171

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

IS - 2

ER -

The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction: a comparison survival in two cohorts collected in 1995 and 2003

Abstract

Keywords

UN SDGs

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